What You Should Know About A Significant Change To Type 2 Diabetes ICD-10 Coding

There have been some changes to the ICD-10-CM Official Guidelines for Coding and Reporting that affect podiatrists. These changes are for the 2017 fiscal year and went into effect October 1, 2016. There are now specific codes for bunion, bunionette and bilateral tarsal tunnel syndrome. There was also a significant change involving coding for type 2 diabetes.

In the first year of ICD-10, all of the E11- codes for type 2 diabetes carried the instruction to “Use additional code” to identify insulin use with Z79.4. This means if the patient uses insulin, we are supposed to include that code. “Use additional code” means the order matters and the additional code should follow the code you are adding it to. Up until October 1, 2016, there was no requirement to code the use of oral hypoglycemic medication use.

Now that has changed. All of the E11- codes still carry the instruction to add on Z79.4 for insulin use but now also carry the instruction to “Use additional code to identify use of oral hypoglycemic drugs” and that code is Z79.84.

This is a significant change because for the last year, the need to add an additional code to identify insulin use in a patient with type 2 diabetes was the exception to the norm. However, now most type 2 diabetes codes will require an additional code in the form of either Z79.4 or Z79.84. If you see a patient with type 2 diabetes, who is either diet controlled and not using any type of medication, or not using any medication for another reason, you should add neither of these codes to the E11- code. However, this will be the exception to the rule as most patients you see with type 2 diabetes will be on some type of insulin and/or oral medication in an attempt to control their glucose levels.

Resources

1. Bryant G. ICD-10-CM official coding and reporting guidelines; noteworthy changes and revisions for 2017. ICD10 Monitor. Available at https://www.icd10monitor.com/enews/item/1679-icd-10-cm-official-coding-and-reporting-guidelines-noteworthy-changes-and-revisions-for-2017 .

2. American Podiatric Medical Association Coding Resource Center. Available at https://www.apmacodingrc.org/home.asp .

Dr. Lehrman is on the APMA Coding Committee, serves and is a Fellow of the American Academy of Podiatric Practice Management (AAPPM). Follow him on Twitter @DrLehrman